All About Psychopathy

Psychopathy is a form of antisocial behavior that leads that occurs with traits like impulsivity, lack of empathy, and stunted or low emotional development. While psychopathy is not formally defined as a mental health condition in the Diagnostic and Statistical Manual 5 (DSM-5), it is a subtype of antisocial personality disorder ASPD.

If you or a loved one may have some traits that align with psychopathy, seeing a mental health provider for support is an important first step. Treatment options are currently limited, but researchers are hopeful that studies can find more effective treatments.

Symptoms and Traits of Psychopathy

The hallmark traits or symptoms include:

• Lack of empathy
• Manipulation
• Deceit
• Having a big ego
• Lack of remorse
• Limited emotional responses
• Recklessness
• Impulsivity
• Behavioral problems (especially among children)
• Violence or aggression

Many people with psychopathy maintain an outwardly normal appearance and even appear charming and witty. Although psychopathy is often associated with criminality, the defining features of psychopathy are the above personality traits, not violent or criminal behavior.

Some people with psychopathy are also considered “integrated psychopaths” due to their nonviolent tendencies. Other people living with this condition may be defined as “successful psychopaths” in that they are quite successful throughout their lives and harness aspects of psychopathy that benefit their individual growth, such as confidence, congeniality, and fearlessness.

Types of Psychopathy

Some researchers group psychopathy into two categories: primary and secondary. Secondary psychopathy is generally more common than primary psychopathy.

Primary Psychopathy

People with primary psychopathy may possess the following traits:

• Tendency to lie
• Lack of guilt or regret when harming someone else
• Being manipulative
• Callousness or insensitivity
  

Secondary Psychopathy

Secondary psychopathy is often associated with autism, ADHD, alexithymia (a condition in which people have trouble feeling emotions), and anxiety. People with secondary psychopathy may experience:

• Impulsivity
• Overwhelming frustration 
• Difficulty focusing on long-term goals
  

What’s the Difference Between Psychopathy and Sociopathy?

Psychopathy is often linked to antisocial personality disorder (ASPD), which is sometimes also called sociopathy. Many researchers classify psychopathy as a severe form of ASPD, but psychiatric research continues to examine the differences and similarities between the two conditions.

Psychopathy and ASPD share common features, especially those that relate to antisocial behavior or disruptive behavior that deviates from the norm. People with psychopathy are particularly likely to appear charming and overly self-focused, which is not always the case among people with ASPD. They also may be more violent than people with ASPD. However, people with ASPD may be more emotionally responsive.

What Causes a Person To Develop Psychopathy?

Research shows that psychopathy is strongly linked to your genetics, which means that if a family member experienced it, you may be more likely to develop it than someone who does not have a family history. However, as with other mental health conditions, genes and biology cannot alone make someone experience psychopathy. Rather, it’s the combination of your genetic makeup with your early experiences in your environment that can lead you to develop psychopathy.

The genetic component of psychopathy can be attributed to changes in the genes that affect your empathy and emotions. These are the same genes that can be tied to autism, which make it hard for people to identify with other people's emotions.

In combination with genetics, early childhood trauma can also make you more susceptible to developing psychopathy. In particular, if your parent or other caregiver isn’t responsive to your emotional or physical needs as an infant or throughout the first two years of your life, it can affect your brain development. This may then affect how your brain responds to stressful situations throughout your life.

How Is Psychopathy Diagnosed?

If a mental health provider suspects that you may have psychopathy, they may complete one of several assessments. Psychologist tests like Hare’s Psychopathy Checklist-Revised (PCL-R), Hart et al.’s Screening Version (PCL-SV), and the Self Report Psychopathy Scale (SRP-III) all measure several aspects of psychopathic behavior.

The PCL-R is considered the “gold standard” for evaluating psychopathy. To make a psychopathy diagnosis, a mental health provider may conduct an interview and analyze the information in your medical records. This test consists of 20 items and has a maximum scale of 40, with 25 or 30 used as a cut-off score for psychopathy. The PCL-SV is a shorter version of the assessment that consists of 12 items and a cut-off score of 13 or 18. Providers using the PCL-SV don’t use an interview, just information based on your psychological and medical charts.

If your provider suspects your psychopathy aligns with ASPD, they may make a formal diagnosis. But it's worth noting that children cannot be diagnosed with ASPD—and that's because personality disorders require you to be at least 18 before receiving a diagnosis. Children exhibiting antisocial or psychopathy-related traits may instead be formally diagnosed with oppositional defiant disorder or conduct disorder.

Treatment Options

Traditionally, treatment for psychopathy has had limited effectiveness. For the most part, people who experience psychopathy may find it difficult to identify their traits or faults and therefore may be less receptive to treatment.

Unfortunately, previous treatments have focused on reducing violence among incarcerated people (people in jail or prison), rather than treating psychopathy through a lens of trauma-informed care. Due to the stigma of psychopathy and its relationship to criminality or violence, treatment options for psychopathy have been historically problematic.

Nowadays, some mental health providers may instead use treatments that are helpful for other trauma-based conditions. Evidence shows that treatment for ASPD that is focused on rewarding positive behavior and discouraging negative behavior can be effective. These treatments often include some form of talk therapy.

New treatments focus on addressing early indicators of unhealthy development among young people and rewarding their positive behaviors. This is especially important since youth are more likely to respond to cues of societal norms than adults are. Some interventions also focus on reducing youth recidivism (or, the chance that a young person relapes into another act of criminal behavior) at juvenile justice centers.

Coping With Psychopathy

If you or a loved one are living with psychopathy, it’s important to seek care from a mental health provider. They can help you develop traits that will support your growth and allow you to better navigate social situations. Your responsiveness and attention to participating in the process are essential for the success of your treatment plan. 

Specifically, research shows that if people with psychopathy develop conscientiousness, they can self-regulate more effectively and reduce their antisocial behavior. You may even find that you’re able to develop these skills more quickly than some of your peers who don't have psychopathy.

If your friend or family member experiences psychopathy, your support can help guide them in their treatment journey. However, it’s important to take care of yourself and seek the mental health care you need to cope, manage your stress, and set boundaries with your loved one. Talk therapy may be helpful for you too.

A Quick Review

Psychopathy is a mental health condition that causes limited emotional responses, impulsivity, and lack of empathy, among other traits. While this condition is not a formal diagnosis, it's closely related to antisocial personality disorder (ASPD) and often has many of the same symptoms. Not everyone with psychopathy seeks treatment, but many people who do can develop important social skills that allow them to contribute to society productively.